How is surgical antibiotic prophylaxis prescribed for open reduction internal fixation procedures by Australian orthopaedic surgeons?

Abstract

Surgical antibiotic prophylaxis (SAP) reduces the risk of surgical site infections following open reduction internal fixation (ORIF) procedures. Current guidelines recommend the use of single-dose prophylaxis for ORIF procedures. It is known that adherence to SAP guidelines is suboptimal across multiple surgical disciplines, including orthopaedic surgery. The aim of this study was to identify how Australian orthopaedic surgeons self-report prescribing of SAP for ORIF of closed fractures and whether practice adheres to recommendations in the Therapeutic Guidelines: Antibiotic version 16. An online survey was distributed to Australian orthopaedic surgeons between August 2020 and February 2021. The survey consisted of 10 questions relating to SAP prescribing practice for ORIF of closed fractures, guideline awareness, and factors that influence prescribing. Twenty-two surgeons participated in the survey. All 22 surgeons reported prescribing the guideline-adherent agent cefazolin for ORIF procedures, with 68.2% (n = 15) prescribing the non-adherent agent clindamycin for patients with a severe penicillin allergy. Almost two-thirds of the surgeons (63.6%) prescribe postoperative antibiotics, with two postoperative doses the most common regimen (57.1%). Although 63.6% of surgeons were aware of guideline content, adherence to guidelines varied. Surgeons noted that multiple factors influence their prescribing practice, including knowledge gained from personal readings (77.3%), habits developed during training (68.2%), and discussion with colleagues (63.6%). Factors that influence SAP decision making for ORIF procedures are multifactorial, with variable levels of guideline adherence. This small cohort of surgeons commonly reported prescribing postoperative antibiotics. Further research is required to understand what influences SAP decision-making.